Colorectal cancer (CR) is the second leading cause of cancer-related deaths in Germany. Screening strategies have been shown to be effective in reducing CRC mortality. One priority has to be identifying persons at increased risk of developing CRC. Family history is one important factor. Persons at risk of developing hereditary forms of CRC have to be included in specially-adapted surveillance schemes. To increase the efficacy of the surveillance programs the co-operation of the population at large must be improved. As 90 percent of colorectal carcinomas arise from adenomas, a consistent and rigorous polypectomy will lead to a reduction in CRC incidence. Persons with adenomas have an increased risk of recurrence after polypectomy and should hence be followed up. If the removed polyp contains a carcinoma further measures depend on its histo-pathological staging.